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General NPI Number Information
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NPI Number | 1285004374
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Entity Type | Individual
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Provider Name | KEL MAISENBACHER LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 3210 30TH AVE # 2L
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City | LONG ISLAND CITY
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State | NY
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Zip | 11102-1562
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Country | US
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Telephone | 929-244-3779
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Fax |
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Provider Business Mailing Address
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Address Line | 3210 30TH AVE # 2L
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City | LONG ISLAND CITY
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State | NY
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Zip | 11102-1562
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Country | US
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Telephone | 518-821-5932
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW1141265
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089.0136642
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 086705-1
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License Number State | NY
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